| NPI | 1902273667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1857056) |
| Additional Taxonomies | 122300000X Dentist (Licence: NH 04182) |
| Enumeration Date | 2015-08-28 |
| Last Update Date | 2022-10-22 |